HomeMy WebLinkAboutFIREQORK PERM. APPL. 5/21/2012APPLICATION FOR PERMIT Bakersfield Fire Dept.
Fire Prevention
PUBLIC FIREWORKS DISPLAY 1501 Truxton Ave.
Bakersfield, CA 93301
we, Pyro Spectaculars, Inc.
hereby make application for permit to conduct a display of fireworks by the California State Health and Safety Code, and
agree to comply in every particular with the law pertaining thereto as set forth in Part 2 of Division 11, Division 12, and other
applicable sections of the Health Safety Code, and the Rules and Regulations adopted by the State Fire Marshal.
SPONSORING ORGANIZATION:
Rio Bravo Fireworks Committee
ADDRESS:
15200 Casa Club Drive; Bakersfield, 93306
PERSON IN CHARGE OF DISPLAY & PHONE No. LOCATION OF DISPLAY:
Ron Fernandez (559) 303 -7465 Rio Bravo Country Club; Bakersfield
DATES OF DISPLAY: TIME OF DISPLAY:
July 4, 2012 9:00 PM - 9:20 PM (ap rox)
DATE AND TIME OF INSPECTION (2 HOUR NOTICE PRIOR TO DISPLAY) PYROTECHNIC OPERATOR IN CHARGE (LICENSE NUMBER & PHONE No.)
Ron Fernandez Lic# 2431 -02 Ph# (559) 303 -7465
TYPE OF DISPLAY: ® AERIAL 0 LOW LEVEL SET PIECES DEVICES 0 MANUAL ELECTRIC WIRELESS
DESCRIPTION OF ALL PRODUCT TO BE FIRED
Note: If additional space is necessary provide & attach for the following:
HIGH LEVEL AERIAL (approximately 200 -1000 ft.) GROUND (geometric patterns, brightwork etc.)
180- 3" Single Break Aerial Shells, 10 -3" Salutes
120 - 4" Single Break Aerial Shells, 2 -2.5" Multi -Shot Devices
63 - 5" Single Break Aerial Shells, 2 -3" Multi -Shot Devices
LOW LEVEL 11 (approximately 150 -300 ft.) SET PIECES
LOW LEVEL I (approximately 50 -200 ft.) SPECIAL PYROTECHNIC DEVICES
10 - Multi -Shot Device(s)
DESCRIPTION OF STORAGE FACILITIES AND LOCATION ON GROUNDS:
Ready Box
INSURANCE /LICENSE
WORKERS COMPENSATION: GENERAL LIABILITY INSURANCE: DATE
Cartificata Attachad) 0803749 -10 Certificate Attached) CA000002771 -25 May 21, 2012
GENERAL PUBLIC DISPLAY LICENSE NO. THEATRICAL LICENSE No. SPECIAL EFFECTS LICENSE No.
ISSUED BY CALIFORNIA STATE FIRE MARSHAL) GPD -0672
APPLICAN S SIGNATURE APPLICANTS ADDRESS
PO Box 2329; Rialto, CA 92377
PERMIT PAYED GY(/
PERMIT RANTED FOR PUBLIC DISPLAY OF FIREWORKS TO BE HELD 7
O'QENIED A 4 /1 DATE
SIGNATURE
to File 1 - DUDlicate Coov to Permittee
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